U.S. health officials are looking closely at vitamin E acetate as a potential cause of the severe lung injuries that have sickened thousands of Americans who have used vaping devices, including more than three dozen who died as a result.

A study of fluid taken from the lungs of 29 patients battling the condition found all of them contained vitamin E acetate, according to a report from the U.S. Centers for Disease Control and Prevention released on Friday. The samples sent to the CDC came from 10 different states and provide the first biological link in the investigation, a finding that bolster’s the agency’s confidence in the results, said Anne Schuchat, principal deputy director of the CDC.

Vitamin E acetate is a gummy syrup that some illegal makers of vaping liquids add to products containing THC, the psychoactive chemical found in marijuana, in order to reduce the amount of active ingredients they need to use. The New York State Department of Health flagged vitamin E acetate as a potential cause in early September, when it found the compound in products it tested that had been used by patients with the lung damage.

“These new findings are significant,” Schuchat said in a conference call, declaring the discovery a breakthrough in the investigation. “For the first time we have identified a potential toxin of concern, in biologic samples. These findings provide direct evidence of vitamin E acetate at the primary site of injury.”

The agency is continuing to investigate the outbreak, both to determine how the vitamin E acetate causes the lung damage and to see if there are any other components that can contribute to the injury. At the moment, the CDC doesn’t have any other chemicals that are on a priority list for examination because it has already worked through the most prominent suspects, agency officials said.

THC was detected in samples taken from 23 of the 28 patients tested, including three who said they didn’t use cannabis-based products. Byproducts of nicotine were found in 16 of 26 specimens tested.

The findings don’t mean that consumers who use only nicotine-containing e-cigarette and vaping products, or rely only on cannabis-based oils obtained from licensed dispensaries, are safe, Schuchat said. There have been anecdotal reports of people falling ill after using products obtained from dispensaries, she said, and some patients reported using only nicotine. The agency continues to recommend that people concerned about contracting the damaging lung condition refrain from vaping or using any type of e-cigarette, she said.

“The data are pointing to the illicit supply” of vaping products, she said. “But this is a very severe disease that can be fatal. I don’t think we can take dispensaries out of the equation.”

Vitamin E acetate is widely used in food and skin-care products, where it is safe, Schuchat said. There is a distinct difference, however, between inhaling something, or putting it on your skin, and swallowing it. Previous studies have found that when vitamin E acetate is inhaled, it may affect lung function, she said.

Black Market

The number of Americans sickened from vaping-related lung injuries has been steadily increasing, though there are indications that the outbreak is slowing. As of Nov. 5, there were 2,051 cases reported in 49 states, the District of Columbia and one U.S. territory, the CDC said on Thursday, with 39 confirmed deaths.

Regulators had signaled in recent weeks that the outbreak was likely tied to the use of black-market vaping products containing THC, though they hadn’t drawn a direct link to any one product, behavior or ingredient.

There are hundreds of devices and ingredients at play in the vaping market, and not all are legal, which has made identifying the source of the outbreak much more difficult.

The rash of illnesses has coincided with increasing alarm about use of e-cigarettes and vaping devices by teens. According to the 2019 National Youth Tobacco Survey, about 4.1 million high-school students and 1.2 million middle-school students will have used vaping products at some point this year.

With assistance from Timothy Annett.

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